ONC Local Grants Announcement
At ONC, we’re making tremendous progress to achieve our goals and today, I wanted to provide a quick update and an important new announcement.
Although I’m often out front in communicating our goals and progress, there is an entire organization – plus numerous collaborating agencies, our federal advisory committees, and other stakeholders – behind me working harder, and faster than ever, to get the right pieces in place to meet very aggressive timelines.
You have seen evidence of that work already with our announcements of major grant programs to help establish health information exchange and grow the health IT workforce. And you’ll see even more in the weeks and months ahead as we roll out new projects.
Already, we’re on the way to getting the Regional Extension Centers and the State Health Information Exchange program established early in 2010. In fact, on a technical assistance call on Friday about the extension center program, we announced that, due to a strong response for applications, there will be approximately 30 extension center awards made in January and the remainder in March. This should assure support is in place for providers looking to become meaningful users of EHR systems leading up to 2011.
Of course, this isn’t all we’re doing. You will see meaningful use criteria (from CMS) in a matter of weeks. We also anticipate publishing in early 2010 our proposed plans for establishing a new certification program, which we believe will enable most vendors to have their products certified by 2011. And there will be a number of other awards and programs rolling out between now and the end of the first quarter. This past week’s announcements of the Beacon Community Program and additional workforce training grants continue to build the needed foundation for electronic health records throughout the nation.
We’re working hard and we’re working fast, but we’re also working smart and ensuring that the necessary programs and standards serve as a sound foundation.
|
I’m pleased with the speed of progress made so far. Things are actually ahead of where I thought they would be by now…
I would like to know why the Office of the National Coordinator for Health Information Technology is holding the first work group meeting on privacy and security Tuesday in a closed-door session. This seems to cut against the grain of this administrations emphasis on transparency. Wouldn’t it make more sense to have this meeting held in the open and encourage greater participation in the discussion?
Will the VA and DoD participate in the HIE system?
I am very impressed with the progress being made as well. However, and there is also a “however”, realistically speaking, it is very unlikely that the bulk of EMR adoption will occur in 2010, which means that the vast majority of providers will not qualify for the full stimulus funding.
From what I see out there, most docs are trying to get on board with HITECH and want to become “meaningful users”. Whether it is from a firm belief in technology or just for the financial incentive, they realize that they must computerize their records sooner rather than later and everybody is counting on the full stimulus amount in budget calculations.
It would be very demoralizing for the medical community when somewhere in the summer of 2010 a large number of providers realizes that they are behind schedule and will not qualify for the 2011 stimulus.
So…. would it be possible to consider a plan B? Maybe something like a binding letter of intent, which upon execution, qualifies these folks for full stimulus starting in 2012, or maybe something similar.
It doesn’t have to be announced right away, so we maintain a sense of urgency, but when the time comes, we should have a prepared strategy, that will carry the good will into another year of, hopefully, widespread EMR adoption.
Margalit,
My understanding based on analyses I’ve seen about the payout schedule is that a provider doesn’t HAVE to start in FY 2011 to get “full stimulus funding.” For example, if they started in FY2012 or even FY2013, they could still get the same amount of incentive money, although they would start receiving it later. Of course, we need to see the CMS rules to know the final decisions about timing, e.g., which capabilities must be in use by which dates.
David,
If they start in 2012, they can get the full amount. However if they start in 2013, they will lose $5000 (under Medicare) and $9000 if they start in 2014. Starting in 2015 will not pay anything. This is all for ambulatory providers in areas with no shortages of physicians.
The point is that we have hundreds of thousands of docs without an EMR and there may be very good reasons why some of them would take longer than others.
My guess would be that, particularly in the current economy, the least financially able providers will be the last ones to purchase technology, and they will also be the ones to receive less stimulus funds according to the current CMS schedules. It doesn’t seem right somehow.
Thanks, Margalit. I was looking at the HOSPITAL incentive payout timeline, and hospitals CAN start in FY2011, FY2012, or FY2013 and still get full incentives. I had (incorrectly) assumed that physicians would have the same timeline except for being on calendar year rather than FY. But you’re right that ELIGIBLE PROVIDERS would only get full incentives if they start in 2011 or 2012. Thanks.
When to start / purchase becomes an interesting question.
What about ICD-10 in 2013 and the evolving “meaningful use criteria” from 2011 (collection) 2013 (process improvement) 2015 (clinical improvement) – I could buy a system once in 2011 that can “collect data” – but have to purchase a completely overhauled system for ICD-10 and to be able to really do population management and patient care that “moves the needle” on patients that don’t routinely come into the office (and those that come in for symptom-based care).
It continues to feel as if one of the biggst issues is thinking of all EHRs / EMRs as interchangeable — in fact, different systems have been designed for different purposes. HIT systems, true EHRs, designed from the ground up to solve the issues of care are few and far between.
The Vermont Blueprint for health has been making some great strides toward true community-based medical homes, driving real care coordination – across care settings. It’s not the only example to be sure & the beaon grants should show even more examples front and center.
At the end of the day, though – the business drivers for creation and purchase of EHRs / EMRs designed (not retro-fitted) to improve care is just now emerging.
What are the issues of care? (and use)?: fast structured data collection (no productivity loss); decsion support at the point of patient care WITHIN WORKFLOW (not distrupting workflow); performance reporting for payment and monitoring as a by-product of care delivery (rather than a separate task) and finally population management (ability to reach out to patients who need care or need monitoring) — all on a back drop that includes the patient and allows team-based communication.
The answer feels like part point of care, part warehouse, part exchange, part quality reporting – the best of worlds across EMRs, HIEs, Business Intelligence, Wikis, Secure Communication — What do we call such a new beast?
John Haughton MD, MS
DocSite
We will call it Microsoft Clinical Office, powered by Sentillion.
One, all inclusive, dashboard transparently signing on into a variety of applications, maintaining patient and user context across all disparate products.
I remember working on stuff like this 5 years ago, but the technology wasn’t ripe and the market drivers weren’t there. All stars have aligned now. If done right, it should be a magnificent and disruptive offering. I envy the folks that get to work on it….
Greetings from Boston Dr Bluementhal!!!
Great to have this new info exchange site..
My question/concern as the director of a trade association for 140 home health agencies/VNAs is that HITECH funds seem to be bypassing post acute/long term care providers (home health agencies are both). States seem committed to – under impression that – all funds are to used for MDs and hospitals… I read contradictory statements on this.. clearly much of what we do fits into the “meaningful use” criteria. Response?
Dr. Blumenthal writes: “We also anticipate publishing in early 2010 our proposed plans for establishing a new certification program”.
Section 3004.b.1 of ARRA reads: “Not later than December 31, 2009, the Secretary shall, through the rulemaking process consistent with subsection (a)(2)(A), adopt an initial set of standards, implementation specifications, and certification criteria for the areas required for consideration under section 3002(b)(2)(B).”
Why is there no mention of this critical deliverable in the message above, only the reference to meaningful use definition by the end of the year (which is, of course, a separate concept under ARRA)? Does the vague reference to “proposed plans for establishing a new certification program” in early 2010 include this deliverable, meaning that ONC will miss the statutory deadline? If not, when will we csee the “standards, implementation specifications, and certification criteria” that will be used to define requirements for “certified EHR technology” under ARRA?
Of note, section 3004.b.2 of ARRA goes on to state: “The standards, implementation specifications, and certification criteria adopted before the date of the enactment of this title through the process existing through the Office of the National Coordinator
for Health Information Technology may be applied towards meeting the requirement of paragraph (1).” This refers, of course, to CCHIT (presumably 2008) certification. Will ONC devolve to that for the 2011 certification requirements?
Thanks for your blog, Dr. Blumenthal. I had thought that the ONC proposed regulations on certification process would be issued in December along with the CMS meaningful use NPRM and the ONC Standards and Certification regulations. When you said “We also anticipate publishing in early 2010 our proposed plans for establishing a new certification program, which we believe will enable most vendors to have their products certified by 2011.” that seems later than many people expect. Can you clarify whether the “proposed plans” are the anticipated ONC Certification Process NPRM/IFR and, if so, whether the date is really 2010 rather than 2009?
I would just like to post a compliment from Canada regarding the effort that is being made to keep communication channels open regarding the EHR and IT progress in the US. One of the gaps in Canada has been a lack of openness and transparency regarding the status of current and future programs. The establishment of strong governance to facilitate the type of discussion that is a critical success factor. As the program begins to gain momentum, the need for multiple channels of communication becomes ever more important. From the end-user perspective, physicians and other care providers will usually give leeway if they understand how the changes will impact them personally. It is important to know what is going on from a national program perspective, but even more important to be able to understand how they fit in the big picture. ‘Tell me what I have to do, when and how it is going to impact my patients and practice’. What many physicians want to know is how disruptive and for how long. Keeping the communications relevant and frequent is a great step in that direction.
All this seems like much ado about nothing, as far a small medical practice is concerned. I am still trying to figure out how the most important piece in health care (the physician) can actually meaningfully participate in all this….can’t clearly define what to call this!
Does this mean that CCHIT will be history and now EMR vendors must certify under a new entity? Will that cost pass on to the users (medical practices)? There is still too much secrecy and complication. Why would we expect anything else? Could anyone educate/enlighten me?
I am so happy to see things progressing. As an IT professional, I am excited to see this. I am going to host a monthly roundtable monthly open to medical staff who want to learn about computer technology. It’s my way of contributing to those that want to learn.
Thank you for all you’re doing,
Darren Valukis
IT consultant
Tech Options Inc.
With intellectual property claims for a national IT (LDAP/X.500) root image of the U.S., in virtual terms, c=US is able to turn on secure and private national and local identity for 330 million people.
The government is currently prohibited by Congress from doing so, (except for health professionals, first responders, etc. which is currently already being done). Consider one of the basic points of “Zen and the Art of Motorcycle Maintenance”, where is the quality? Babbage provides an answer, you need a container to create meaning. That’s not a web site. That’s not a corporation. That’s the sum total of the original ideas and requirements carried forward into a more virtual world.
The meaning of meaningful use? It’s there, but profoundly fragmented, and thus requires a meta layer.
It’s just a start tho, (catching up with 1988), HHS requirements for security and privacy, where Congress spoke saying, hmm, you guys *really* don’t have your game on, do you?, we don’t trust you with security and privacy yet. Now is considerably later, than then. Now it’s about the train wreck ahead. A failure here will be profound.
So the government part is already done. That leaves the rest of the U.S. to organize itself into a consistent approach, incorporating the current approaches to identity management. Horton hears it…. The voices of the patients starting to sing with one voice. Come on, you can do it! But not alone.
One has to have a consistent national identity architectural IT image in order to prevent the current IT fragmentation brought on by multiple vendors and contracts, every corporation understands this, which is how they do things. Wonder why these system don’t “talk” to each other? There’s your answer, they were designed not to, despite the efforts of standards creators.
States understand this. Privacy officers understand this. But incentives are simply not there to solve the problem, really. Too much money to be made in keeping the organization from the patients.
However, current efforts will have some useful, if incremental results. No one is seriously interested in solving the problem nationally, or it would already be done. Yes, within organizations. The problem is the train wreck ahead financially. The system will break down. It is an unsustainable bubble.
There has to be a national policy on health IT identity, which can be translated into a consistent across the board object oriented approach in Health IT terms. That’s a service oriented approach in the architecture. Or to paraphrase Babbage, you need a container to put things in to create meaning.
The government understands this with secure cards, etc. based on this concept. It has already contracted with Verisign to provide secure certificates. The NHIN is somewhat based on this concept of providing a broadcast query as to your identity, as one of the services. But it is currently very cumbersome in its approach to that problem. Why send out your identity to everyone on the network? That’s like the current HIPAA approach which requires us to trust all covered entities. This makes consent useless. Of course we all know that also.
The savings will be in getting patients to be involved in their own care, and manage expenses, and not making the paperwork obtuse to them.
Refocus on the patients, and their needs, even while we understand that there have been valuable insights from the big consulting firms. Seriously, have they developed a real solution in the last twenty years this has been in progress? Not really.
We start building the virtual U.S. Health IT image based on the security and privacy principles that by this point, are already painfully well known. Rinse and repeat.
Multiple connected pipes, and gateways only contribute to the hardening of the arteries of the current organizational structures. The solution is some indirection, at the layer of a national image. Here’s your basic kit, everyone gets it, and then added benefits are layered by value added suppliers to customize and better serve the patient. But the most basic part is a failure right now. Keep it simple, keep pounding on the problem, and persevere.
Look forward to 20% of GDP going to health care in the near future without a solution to fragmentation of organizational structure, as each system fails to communicate using common protocols and standards that already exist and are available.
The delay in publication of the certification draft rule (originally scheduled for 12/09) and the rumored delay in publishing the “meaningful use” draft rule (scheduled to be published by CMS 12/09) will adversely impact entities who are interested in implementing EHRs and EMRs that will improve HIE and are, at least to a degree, basing a “sooner rather than later” implementation approach on federal EHR Medicare and Medicaid incentive dollars. Also, given capital needs to be invested by health care professionals interested in taking advantage of incentives before any incentive reimbursement/payment is realized, smaller practices are at a distinct disadvantage.
Generally it takes close to a year to implement a new EHR or EMR. If the two rules are not final until May, vendors will need time to reprogram or upgrade, the government will need time to certify and only then can organizations select or upgrade to an EHR that can be actively used to demonstrate “meaningful use.” it is likely that a number of health care professoinals (especially small to medium sized practices – who represent the greatest number of providers in this country) would not be in a position to take advantage of federal incentives until late calendar year 2011.
I think the reqirement to convert to ICD 10 also needs to be taken into account when estimating the positive impact of incentives included in ARRA. As an example, if I represent a small to medium sized provider, is it cost effective to implement a new EHR or EMR or upgrade my existing application to take advantage of incentives late in 2011 and then be required to upgrade that application in 2012 to meet the ICD 10 requirements? If the EMR/EHR is ICD 10 compatible and certified, this is not necessarily an issue but if it isn’t, it is likely not cost effective to invest the dollars to implement/upgrade and then almost immediately upgrade again.
I hope ONC is considering how to incentivize small providers (especially in underserved areas) to invest in the appropriate technology. There are a number of different ways this can be accomplished and not all need to be paid for by stimulus dollars. The bottom line, though, is the “stick” (Medicare payment reduction) in the legislation that is intended to incentivize investment may work in some states with high Medicare reimbursement rates but not in others where Medicare beneficiaries are sometimes hard pressed to find evena privary care physician who will take Medicare patients. In those cases, the “stick” is not a “stick” at all given low percentages of Medicare care by these health care professionals.
You refer to “Delay in publication fo the certification draft rule (originally scheduled for 12/09)”.
However, the deliverable required under the ARRA statute (see my post below) by 12/31/09 is a FINAL rule (though it may be labeled an “interim final rule”) covering “standards, implementation specifications, and certification criteria”, NOT a proposed or draft rule. If one is not issued by 12/31/09, then the Secretary of HHS is in violation of the statute.
There really is NO excuse for HHS to fail to meet this deadline, since the statute gives them a very clear “out”: HHS may choose to utilize the “standards, implementation specifications, and certification criteria adopted before the date of the enactment of [ARRA] through the process existing through the Office of the National Coordinator for Health Information Technology.” That means CCHIT 2008 Certification. If ONC cannot come up with its own deliverable here then the only legal option is to declare all CCHIT 2008 certified EHRs to qualify as “Certified EHR Technology” for the EHR incentive program for 2011.
The specific language Dr. Herzenstube refers to is on page 126 of the bill, in section 3004, and says:
‘‘(b) ADOPTION OF STANDARDS, IMPLEMENTATION SPECIFICATIONS,
AND CERTIFICATION CRITERIA.—
‘‘(1) IN GENERAL.—Not later than December 31, 2009, the
Secretary shall, through the rulemaking process consistent with
subsection (a)(2)(A), adopt an initial set of standards,
implementation specifications, and certification criteria for the
areas required for consideration under section 3002(b)(2)(B).
The rulemaking for the initial set of standards, implementation
specifications, and certification criteria may be issued on an
interim, final basis.
‘‘(2) APPLICATION OF CURRENT STANDARDS, IMPLEMENTATION
SPECIFICATIONS, AND CERTIFICATION CRITERIA.—The standards,
implementation specifications, and certification criteria adopted
before the date of the enactment of this title through the
process existing through the Office of the National Coordinator
for Health Information Technology may be applied towards
meeting the requirement of paragraph (1).
HHS has not followed legislated mandates before. HIPAA passed in 1996 included the provision that we would have a national health plan identifier and that it would be done in 18 months from the time the legislation was passed! They only missed that one by 13+ years so far
The Center for Media Research has released a study by Vertical Response that shows just where many of these ‘Main Street’ players are going with their online dollars. The big winners: e-mail and social media. With only 3.8% of small business folks NOT planning on using e-mail marketing and with social media carrying the perception of being free (which they so rudely discover it is far from free) this should make some in the banner and search crowd a little wary.
http://www.onlineuniversalwork.com
I think the reqirement to convert to ICD 10 also needs to be taken into account when estimating the positive impact of incentives included in ARRA. As an example, if I represent a small to medium sized provider, is it cost effective to implement a new EHR or EMR or upgrade my existing application to take advantage of incentives late in 2011 and then be required to upgrade that application in 2012 to meet the ICD 10 requirements? If the EMR/EHR is ICD 10 compatible and certified, this is not necessarily an issue but if it isn’t, it is likely not cost effective to invest the dollars to implement/upgrade and then almost immediately upgrade again_?
In those cases, the “stick” is not a “stick” at all given low percentages of Medicare care by these health care professionals.
It would be nice if the VA and DoD participates in the HIE system. I’m also wondering if they are.
Seeing that it is early 2010, has the new certification program been released yet?
Hey,
Thank you for this. Just made my day… kinda late, but as an IT professional this is good news.
Thank you for this. Just made my day… kinda late, but as an IT professional this is good news.
I would just like to post a compliment from Canada regarding the effort that is being made to keep communication channels open regarding the EHR and IT progress in the US. One of the gaps in Canada has been a lack of openness and transparency regarding the status of current and future programs.
It’s amazed me for years how tough it is to make the transition from normal (non-health related) IT into the health related IT world. It seems almost impossible. I know guys that gone from a health IT background into the normal IT world, but I have not had much success going the other direction.
Furthering the use of electronic health records, as long as privacy is protected, is a great way to ensure that patients are treated in a manner and way that allows for them to have better service and safer office visits. When my wife was treated at the Mayo Clinic I was blown away by their system and how integrated everything was. It was amazing to walk from building to building and every medical provider had everything they needed immediately in front of them.
I think that every type of business needs to maximize their time and revenue by efficiently using their it systems. Here in my little Memphis law office I am able to perform on a much grander scale, and better serve my clients because of the systems that I have in place. Everything from CMS to marketing is highly thought out and looked at to make sure that we optimize the technology that is available and out there.
Definitely sounds as if things are going really well so far. Maybe I have missed it, but is there an update on the regional extension centers?
Working fast on this matter is definitely important, but rolling out efficient and successful solutions is probably a more paramount issue!
It really is a big help for IT professionals because they have now the opportunity to work for another field of IT which is health IT. It is also an opportunity for fresh IT graduates because they have added options to what field they are focusing. Although it may be an added expense to the government but it would give new jobs to the people and is very helpful in the medical field.
The article says that in early 2010 there are plans to publish the new certification requirements. Its now Oct..2010 so, I imagine the report is available now. Where can I find the new certification requirements?
Thanks for the great article. I am heading to school in a few days and am going to be back to use some of it for my research if that is ok?